Unraveling the pathological biomineralization of monosodium urate crystals in gout patients Rodríguez Navarro, Carlos Elert, Kerstin Ibáñez Velasco, Aurelia María Monasterio Guillot, Luis Sivera, Francisca Pascual, Eliseo Ruiz Agudo, Encarnación Crystallization of monosodium urate monohydrate (MSU) leads to painful gouty arthritis. Despite extensive research it is still unknown how this pathological biomineralization occurs, which hampers its prevention. Here we show how inflammatory MSU crystals form after a non-inflammatory amorphous precursor (AMSU) that nucleates heterogeneously on collagen fibrils from damaged articular cartilage of gout patients. This non-classical crystallization route imprints a nanogranular structure to biogenic acicular MSU crystals, which have smaller unit cell volume, lower microstrain, and higher crystallinity than synthetic MSU. These distinctive biosignatures are consistent with the template-promoted crystallization of biotic MSU crystals after AMSU at low supersaturation, and their slow growth over long periods of time (possibly years) in hyperuricemic gout patients. Our results help to better understand gout pathophysiology, underline the role of cartilage damage in promoting MSU crystallization, and suggest that there is a time-window to treat potential gouty patients before a critical amount of MSU has slowly formed as to trigger a gout flare. 2024-07-26T07:37:48Z 2024-07-26T07:37:48Z 2024-07-07 journal article Rodriguez Navarro, C. et. al. Commun Biol 7, 828 (2024). [https://doi.org/10.1038/s42003-024-06534-6] https://hdl.handle.net/10481/93498 10.1038/s42003-024-06534-6 eng http://creativecommons.org/licenses/by/4.0/ open access Atribución 4.0 Internacional Nature